Workshop on Enhancing Capacity for Budget Analysis and Advocacy for Women's and Children's Health

27-30 August 2013 Nairobi, Kenya

Sierra Leone Budget Tracking and Advocacy

Background/Context

• Sierra Leone’s Government is spending less than half of what is required to deliver basic health services

• Fluctuating budget allocation, untimely disbursement and effective utilization of funds to the health and sanitation sector

Large funding gap in relation to the Abuja target (2013)?

15% = Le 278 billion

10.5% = Le 195 billion

Le 84 billion

Background/Context

• Out of pocket spending by individuals is extremely high – government spending or insurance coverage accounts for only 25% of total health spending in 2011

• Sierra Leone is far behind in achieving the WHO recommended per capita spend ( eg in 2013 $10 is allocated per person)

Advocacy Objectives

• To have comprehensive, nation-wide information on the flow of Government funds within all levels of the health sector.

• To advocate for increased and efficient use of resources within the health sector.

Advocacy Objectives

• To identify budgetary issues and campaign asks upon which to engage the MoHS, and other relevant health sector stakeholders.

• To help ordinary citizens better understand current resource allocation and the budget process.

Strategy • Coalition (Save the Children & BAN) • Pilot study in 2011 • Coalition expansion and resource mobilization among members

(CSOs, INGOs, • Collaborated with GOSL, Local Councils, DHMT, PHUs, • Signed MOUs with coalition partners • Engagement with the media • Data collection, Draft report and finalized with MDAs • Advocacy activities (media, council, DHMT, Chief of staff, minister) • Election year – manifesto of political parties to prioritize health,

used district electoral forums, score cards, signed petitions, pledge card/audio/ video recording of political commitments

Budget tracking scorecards

• 5600 Citizens Health budget Scorecards distributed nationwide and at electoral forums

• Many candidates pledged to lobby for more funds for MNH

• Petitions were signed by citizens for improved health spending

Some facts

A scorecard displaying for each district money allocated and actually disbursed:

• - For health In the districts

- For the DHMT and to PHUs

- Ranking of the districts according to health

spending

Scorecards:

Petitions Petitions were provided for the moderators

•to collect signatures / marks from citizens •to lobby their candidates •to promise for increased health allocation and better recording and reporting of health finances.

• The petition

Outcomes of Advocacy Strategy

7.9% 7.4%

11%

7.4%

10.5%

0%

2%

4%

6%

8%

10%

12%

14%

16%

2009 2010 2011 2012 2013% o

f tot

al g

over

nmen

t bud

get

Abuja target

% total budgetallocated tohealth

15%

•Increase in allocation from 7.4% in 2012 to 10.5% in 2013

• More funds for Health Now Secured

Outcomes of Advocacy Strategy • Commitment for supplementary budget secured in 2012

Advocacy Outcome

Councils received Q1 & Q2 monies and MDAs received 6 months allocation by mid year in 2013

Political Parties, Chairman, Mayor, Councilors and MPs signed the health pledge

Advocacy Outcome

Advocacy Outcome

• The Abuja15% commitment is a major factor in the govt poverty reduction strategy (Agenda for Prosperity)

Advocacy Outcome

• Public awareness raised on health spending

Advocacy Outcome

• More space provided for CSOs at local and central government in the budget processes

Advocacy Outcome

• Citizens budget now shared by the ministry of finance

• Local council now making budget documents to the public

Challenges to the implementation of advocacy strategy

– Lack of fulfilling commitment by government – Lack of capacity in financial management within

ministries and councils – access to timely information from partners

(councils, INGOs, MOHs, MOFED, DHMT, Donors etc)

– Limited financial support (budget tracking can be expensive)

– Results can be politicized

Media Engagement

Facilitating factors to the achievement of budget advocacy outcome

• Strong coalition building • Political will • Information sharing • Credibility of budget tracking implementing

partners • Civil society space to influence change • Technical expertise within the coalition • Common interest among coalition, ministries,

CSOs,